At the age of 35, a video of Dede Koswara exploded on the Internet. In the video, his limbs are covered with "branches" and have completely lost their normal shape.
In the close-up, some mosquitoes stop in the crevices of the "branches" of his feet, and several flies crash head-on in the picture, trying to find the most suitable foothold on his feet.
Koswala's hands are covered with "branches"
Image source: HLN NEWS
Prior to that, Koswala worked as a carpenter. And as you can see, he is now a "tree man".
The "Tree Man" in Reality
Indonesia in southern Asia is a place with a forest coverage of 67.8%, and Kosvara spent a happy childhood in this typical rainforest climate. However, this leisurely self-sufficiency was stopped when Koswara was 10 years old.
At the age of 10, Koswala suffered an accidental knee injury. Unlike usual, during the healing of this wound, some new tissue grew from the skin outside his bruised knee. These new tissues look like flat stones and gradually spread throughout the body.
Later, as the knee wound was completely healed, the vegetations on Skowara's limbs did not stop growing, they gradually grew and connected into flakes, and from a distance they looked like rough old bark, and some new roots and branches grew.
Facial skin in Koswala
Image source: Screenshot of a YouTube video
Koswala sought help from a local doctor and tried to remove one of the larger vegetations, but soon the vegetation at the site of the incision recurred.
Trapped in this mutated body, Koswara needs to rely entirely on others to complete his daily life. As a result, he lost his old job, his wife was separated, and he lived alone.
Koswara's parents offered to live with him, but even with his parents' help, he could not afford to pay for such multiple surgeries.
According to the Los Angeles Times, in order to maintain a normal life, Coswara had to sign an agreement with a carnival owner to participate in the tour as a "strange tree man" and use his strange body to win the audience's joy, so as to obtain a certain amount of financial income.
Fortunately, although the tour was a curious trend, it brought him the attention of the public.
9 surgeries, "Spring Breeze Blows and Grows Again"
In November 2007, a videotape of Coswala appeared on the Internet, and this miraculous manifestation of the disease attracted a lot of attention as soon as it was uploaded.
With the exploration of all walks of life, Koswala finally ushered in the dawn of medicine, and he was sent to a local hospital.
After a series of specialized examinations, the doctors concluded that Koswala suffered from a condition known as EV/Epidermodysplasia Verruciformis, also known as treeman's disease.
According to the existing literature, this is an extremely rare hereditary skin disease that causes a high prevalence of skin cancer.
Therefore, although there is no clear detailed cause, considering that the large number of vegetations on Koswara's skin has been severely affected by normal life and meets the indications for surgical resection, the doctors decided to perform resection for him.
Reuters reported that in August 2008, Koswara underwent a total of nine surgeries. During the operation, the doctor removed the "branches" and thick tree-like skin of his hands, while removing smaller vegetation on his head, torso and feet, and then performed a follow-up skin graft on the traumatized area.
It is reported that this cleaned up a total of 96% of the vegetation on Koswara's body, with a total weight of 6 kg.
After the operation, Koswala's health was greatly improved, and after recovery, he could even begin to use his hands and feet freely again.
Video of the Koswala surgery
It's just that the good times don't last long. The "branches" of Koswara's limbs soon grew again.
Newborn vegetation is like countless species of creatures in the rainforest, claiming their sovereignty in the form of territorial occupation.
Soon, Koswara was transformed back into a "tree man".
At this point, the desperate Koswara repeated a series of new surgeries to remove the overgrown vegetation.
According to reports, since undergoing major surgery in 2008, Koswara has undergone three different types of surgery. The doctor told him, "For the rest of his life, he will need at least two surgical procedures a year to treat newborn vegetations."
However, after each active operation, the constant regeneration of vegetation has repeatedly proved that this is only a temporary solution.
Koswala's hands after surgery
Meanwhile, the Discovery Channel also funded Koswala to conduct a blood analysis that found that he lacked immunity to fight yeast infections.
Local doctors then wanted to test Koswara, but for various purposes, Koswala eventually chose to refuse follow-up treatment.
On January 30, 2016, the 42-year-old "tree man" died at Hassan Sadikin Hospital in Bandung, Indonesia.
Behind the "Tree Man"
According to foreign media reports, Koswara is not the only "tree man" in the world.
In January 2016, 25-year-old Abul Bajandar was also diagnosed with EV, having cleared more than 5 kg of vegetation from his body after 25 surgical procedures.
The long-term surgical treatment overwhelmed the young man, and he chose to temporarily interrupt the treatment. Abul Bajandar's condition deteriorated sharply after treatment was interrupted, and he was told he would need to undergo five or six more surgeries to bring his condition back under control.
Due to unbearable postoperative pain, in June 2019, 28-year-old Abul Bajandar volunteered to have his limb amputated.
Abul Bajandar's hands
Image source: Wikipedia
The two "tree people" did not have a good ending, and in fact, it is not uncommon for patients like them to suffer from EV.
According to the available test data, they all have one thing in common: human papillomavirus (HPV) infection.
Studies have shown that the onset of EV is usually associated with HPV virus types 5 and 8, which patients are extremely susceptible to.
However, according to the Journal of Virology, 80% of people infected with both types of HPV virus are asymptomatic. In other words, infection does not mean that the patient will directly become a "tree person".
In the pathogenesis of EV, genes actually play a more important role than viral infections.
Studies have shown that the EVER1/EVER2 gene complex on human chromosome 17 can restrict viral proteins from entering the zinc storage area in cells, thereby limiting the growth of viruses.
However, in EV patients, one of the genes of EVER1 or EVER2 on chromosome 17 will have a PH mutation, causing it to be inactivated, so it cannot act as a corresponding inhibitory effect against the HPV virus, resulting in overt infection.
It is the superposition of two conditions, viral infection and genetic mutation, that finally leads to the onset of EV.
After understanding the pathogenesis, doctors have proposed several methods for this strange disease. Currently, the most effective treatment is oral aretinoin 0.5 to 1 mg/day for 6 months, which can achieve antiproliferative and differentiation-inducing purposes.
There are also related cases in China: a 36-year-old male patient with multiple limb hyperplasia for 24 years, hands, forearms, feet and calves are covered with pale black brown warts, and multiple large hard skin horns are formed on the surface of the warts, and the warty epidermal dysplasia is diagnosed. With Avi A capsules combined with radiation therapy, the rash basically subsides.
The use of another drug, cimetidine, is highly controversial. In fact, until 4 years after Koswara's death, the medical community has not yet established a very clear conclusion on the treatment of EV.
However, one thing can be determined: although the effect of drug treatment is not obvious, early diagnosis and good patient education, and timely removal of lesion areas according to needs are effective ways to prevent the development of skin tumors.
In the context of exploring treatment, it is important to know that these people who grow "branches" are not "tree people", but a small group of patients who need attention.
This article is reproduced from Lilac Garden, please contact the first public number.
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Planning and production
Curated by: Carollero, Hitomi Heart | Executive Producer: Gyouza
Cover image source: Wikipedia
This article was professionally reviewed by Chen Jiaqi, Attending Physician of the Department of Dermatology, Second Affiliated Hospital of Zhejiang University School of Medicine, and Wu Daxing, Deputy Chief Physician of Tongxiang Skin Disease Prevention and Treatment Hospital